Managers, Nurses and Delegation: Who Has Authority?

Nurses General Nursing

Updated:   Published

So wanted to brainstorm through a situation that came up recently.   At my facility, I am normally a nurse manager for a rehab unit.   Because of the COVID pandemic and fewer patients, I have been moved to assist on the LTC unit.  

The other day, when I went down there, one of the nurses listed off various things they were needing help with down on the unit: med pass, feeding people, vital signs, obtaining daily weights, etc.  I explained to her that I could help out with some things, but that I would still be attending to other duties, such as attending morning meetings and completing telehealth provider visits.  She seemed to understand at that time. 

However, about a day later, a patient had requested an enema in the afternoon. I passed this along to the nurse, who stated she would get to it if she had time.  About 5 minutes towards shift change, she mentioned to me that she had never gotten to it, and that the oncoming replacement was a TMA, who isn't supposed to be giving enemas.  In other words, I believe she was implying that I should be the one to do it.   

I gave her a couple of options: I could help finish up with some of her charting so she would have time, or she could pass it along to the evening supervisor.  I explained that I already had admission orders to review from the other unit.  I believe she ended up passing along the task to the evening supervisor.  From my knowledge, the enema was never  given because the patient ended up having a couple of large bowel movements.  

What I am wondering is who had authority in this situation.  The nurse seemed like she wanted to delegate certain tasks to me, but, as a manager, I would think it would be me that determines who completes which tasks, not her.  I guess I'm not sure what should have been done since we each had different opinions on who should do what.  The patient ended up being fine, but just wondering about future situations like this.  

Who does the delegation? The manager or the nurse?  

Specializes in Psych, Addictions, SOL (Student of Life).
1 minute ago, SilverBells said:

For me, performing many hands on skills makes me feel bad about myself.  I feel bad for the patient too, because I always am thinking that if someone else were doing it they'd be more efficient and do a better job than I would.  Whereas if you give me 5 pages of new medications to enter, they will be entered in no time, unless an order needs to be clarified

As the old saying goes. "Practice makes purfect!" When we first leave school we are in the novice stage of nursing to expert

" Nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences."

It seems as if your talent for admistrative skills was recognized early perhaps due to an immediate need for that skill set.  Cosequently you never developed the strong skill set needed to approach patient care with confidence. Understand that if you are managing/supervising nurses you must have a good handle on these skills as you may be asked to demonstrate them. I actually saw a nurse at a facility "Promoted" to a desk job because she was so bad at hands on skills and the Joint Commission was coming and the admistartion didn't want her on the floor when the surveyors arrived. 

It seems like there are plenty of opportunities to perform hands on care in your department and administrative tasks should not take more than 8 hours if you are well organized. Ask your floor nurses what they are going to be doing today. Perhaps a simple dressing change then observe and offer to do the next one under the guidence of another nurse, Then try one on your own. Honestly you will become a better nurse and better manager by doing this.

I do second others here about speaking with a counseler about ways to develope that work/life balance that is so important. I also recommend going home. Popping some popcorn and watching the original Karate Kid. It's all about balance and control in one's life and performance.

Hope this helps.

Hppy

Petiprin, A. (2020, October 17). Dr. Patricia Benner. Retrieved February 23, 2021, from https://nursing-theory.org/nursing-theorists/Patricia-Benner.php

Specializes in Psych, Addictions, SOL (Student of Life).
8 minutes ago, hppygr8ful said:

As the old saying goes. "Practice makes purfect!" When we first leave school we are in the novice stage of nursing to expert

" Nurses develop skills and an understanding of patient care over time from a combination of a strong educational foundation and personal experiences."

It seems as if your talent for admistrative skills was recognized early perhaps due to an immediate need for that skill set.  Cosequently you never developed the strong skill set needed to approach patient care with confidence. Understand that if you are managing/supervising nurses you must have a good handle on these skills as you may be asked to demonstrate them. I actually saw a nurse at a facility "Promoted" to a desk job because she was so bad at hands on skills and the Joint Commission was coming and the admistartion didn't want her on the floor when the surveyors arrived. 

It seems like there are plenty of opportunities to perform hands on care in your department and administrative tasks should not take more than 8 hours if you are well organized. Ask your floor nurses what they are going to be doing today. Perhaps a simple dressing change then observe and offer to do the next one under the guidence of another nurse, Then try one on your own. Honestly you will become a better nurse and better manager by doing this.

I do second others here about speaking with a counseler about ways to develope that work/life balance that is so important. I also recommend going home. Popping some popcorn and watching the original Karate Kid. It's all about balance and control in one's life and performance.

Hope this helps.

Hppy

Petiprin, A. (2020, October 17). Dr. Patricia Benner. Retrieved February 23, 2021, from https://nursing-theory.org/nursing-theorists/Patricia-Benner.php

Oh and you can present it to your nurses like this; As your manager I would like to have a better understanding of the tasks and skills you perform on a daily basis can you please let me know what you are doing today so I can arrange my schedule to be able to observe what you do."

Specializes in Rehab/Nurse Manager.
5 hours ago, amoLucia said:

Same old song, different posts!! Sorry to say. You're back again, and explaining why you think you're the rightful employee to be selected for CERTAIN personally desired positions and tasks. NOT what Admin/mgt believes is correct for you. Only what you like and avoiding that which you find distasteful.

On a similar post the other day,  you asked 'what skill sets or personality characteristics would be needed for an Admission Coordinator position (one you covet, but have NOT been offered). Well, I'm thhinking TEAMWORK, cooperation, schmoozability, following directions, non-complaining, etc.  I just don't see this with you.

You become defensive after most posts (I expect some zinger for my post here). You point out others' deficits. How much of this has TPTB seen inn you? It's like you toot your own horn.

Sadly, you most likely have some very good attribute skills that would be very desirable for what you seek. But Admin wants a 'whole package' for its team. I just don't see them wanting you for whatever their reasons. And its difficult for you to get past that.

PPs Wuzzie & Jaded both astutely recommended that you seek some counseling or prof help to determine why you have such peculiar career traits as you do.

Good luck to you.

It’s just peculiar what management views as the right tasks to assign to certain people.   For instance, during the morning meeting, for some reason they decided to delegate the task of offering showers to residents who had refused over the weekend to me.   It baffles me because there are many others who probably would have been a better choice as I haven’t given a shower since nursing school 7 years ago.   Meanwhile, there are tasks that were assigned to the other manager that I would have been more than competent at completing.  It’s possible they passed showers on to me because there were only 2 aides for over 30 patients, but I’m also wondering if they are trying to set me up to fail.  I just don’t get their reasoning sometimes. 

Specializes in Rehab/Nurse Manager.
2 hours ago, JadedCPN said:

I think you have a very misunderstood idea of what a good manager and good leader (two different things) are supposed to do. You are an RN. You have the capabilities of doing ANY task that the RNs and aides on the floor can do. And part of your “managerial” tasks involves doing those floor tasks when needed. I don’t understand your thinking.

As strange as it sounds, I almost feel like I did a better job as a newer manager, in regards to helping out with floor tasks.  The longer I’m away from hands on skills, the more anxious I become when asked to assist.  In a way, I’ve become worse over time, not better

Specializes in Pediatrics, Pediatric Float, PICU, NICU.
35 minutes ago, SilverBells said:

It’s just peculiar what management views as the right tasks to assign to certain people.   For instance, during the morning meeting, for some reason they decided to delegate the task of offering showers to residents who had refused over the weekend to me.   It baffles me because there are many others who probably would have been a better choice as I haven’t given a shower since nursing school 7 years ago.   Meanwhile, there are tasks that were assigned to the other manager that I would have been more than competent at completing.  It’s possible they passed showers on to me because there were only 2 aides for over 30 patients, but I’m also wondering if they are trying to set me up to fail.  I just don’t get their reasoning sometimes. 

The fact that you think they would be intentionally setting you up to fail by asking you to do a simple skill like showering, and that you think you’re the only one who can chart a full assessment or history, or that your documentation skills are the best, are all once again beyond “normal” and are highly concerning. It’s not about you but you focus every single thing on you. Please talk to someone professional instead of repeating the same things over and over again on an Internet forum.

Specializes in Mental health, substance abuse, geriatrics, PCU.

I will repeat, that I think this job is just toxic for you. I think you need a little longer at the bedside before you move up the ranks, and there's no same in that. You simple can't sustain what you're currently doing.

Specializes in General Internal Medicine, ICU.
1 hour ago, SilverBells said:

As strange as it sounds, I almost feel like I did a better job as a newer manager, in regards to helping out with floor tasks.  The longer I’m away from hands on skills, the more anxious I become when asked to assist.  In a way, I’ve become worse over time, not better

The only way to get better at something is to do it. I used to shy away from IV starts until I realized that I wasn’t going to get better at them unless I start sticking patients. And that it’s okay if I miss. I now have no qualms about starting IVs—even if I miss, I at least made the effort to try.

Right now you’re not trying, and you’re shying away, and the more you do this, the less competent you’ll be at the hands on skills, which makes you shy away from the tasks even more and not try, which furthers weakens your skills...do you see the cycle yet?

1 hour ago, SilverBells said:

It baffles me because there are many others who probably would have been a better choice as I haven’t given a shower since nursing school 7 years ago.   Meanwhile, there are tasks that were assigned to the other manager that I would have been more than competent at completing.

Are you honestly telling me you can’t give someone someone a shower because the last time you did it was in nursing school?!! Girl, showering someone else isn’t a nursing specific skill. Lay caregivers are able to do it. Teenaged babysitters can do it for the kids they’re watching. Elementary school kids can probably give their younger siblings showers. But you can’t?!

Look, as I said, you’re not going to get good at things you don’t work on. We know you’re amazing at paperwork, but if showering a patient makes you uneasy, then perhaps it is time to focus on the skills that you’re not so hot at.

I’d have very little respect for a manage who can’t even complete the most basic of hands on tasks. What are you going to do if your staff needs help with hands on skills? Or they need you to demonstrate something? 

Specializes in Psychiatric, in school for PMHNP..

Hello Silver Bells, I agree with a lot of the other posts. Short term pain often means long-term gain.  Even if you are uncomfortable doing it, I would get in there and be as hands-on as possible.  You will gain confidence as you gain skills. Also, I would recommend seeing a therapist to discuss your feelings.  

7 hours ago, MPKH said:

Are you honestly telling me you can’t give someone someone a shower because the last time you did it was in nursing school?!! Girl, showering someone else isn’t a nursing specific skill. Lay caregivers are able to do it. Teenaged babysitters can do it for the kids they’re watching. Elementary school kids can probably gI've their younger siblings showers. But you can’t?!

This is a giant smokescreen to cover up that the OP just doesn’t want to do it. OP none of the tasks you’ve been asked to do are beyond extremely basic level nursing. Some of them aren’t even nursing skills. You’re not “good” at them because you’re not even trying while at the same time perseverating on the things you would rather be doing and feel you deserve to be doing. I’m sorry if this sounds harsh but you are creating the issue and you really need some help figuring out what’s going on in your head that makes you behave this way. You can’t possibly be happy with all this angst in your life. 

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
10 hours ago, SilverBells said:

It’s just peculiar what management views as the right tasks to assign to certain people.   For instance, during the morning meeting, for some reason they decided to delegate the task of offering showers to residents who had refused over the weekend to me.   

I'm going to be honest and blunt - they gave you those tasks because they don't view you as a competent manager. 

Specializes in retired LTC.
7 hours ago, klone said:

I'm going to be honest and blunt - they gave you those tasks because they don't view you as a competent manager. 

I'm agreeing.

Specializes in Rehab/Nurse Manager.

After Monday, I spent the rest of the week responding to the tasks that were actually needed.  I did not complete any admission assessments, but otherwise had a nice balance of both administrative and nursing tasks.  If I offered to help with something and was told my assistance wasn't needed, I simply found something else that was equally important to complete.  Sometimes this simply meant answering a call light, obtaining a blood sugar, or assisting with a transfer.  Other times I was asked to follow up on a patient change in condition, write an SBAR, or clarify an order.  Funnily enough, by focusing on the tasks I was actually asked for assistance with and not attempting to "hog" any particular assignment, I was able to work more reasonable hours this week (think 8-10 hours each day, rather than 16-20).  I thought I loved completing admission assessments and reviewing discharge summaries but my week was surprisingly more enjoyable because I didn't try to take over those tasks. 

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